Elsevier

American Heart Journal

Volume 258, April 2023, Pages 140-148
American Heart Journal

Clinical Investigations
Mortality and rehospitalization after mitral valve surgery as a function of age and key comorbidities

https://doi.org/10.1016/j.ahj.2023.01.006Get rights and content

Background

Mitral valve surgery is associated with substantial perioperative risk and long-term complications. Data on long-term outcomes following surgery remain scarce and are hypothetically modified by age and comorbidities.

Methods

This Danish nationwide study included patients ≥60 years of age undergoing mitral valve surgery from 2000-2018. Patients were observed from day of surgery until outcome of interest (ie, rehospitalization or death) or maximum 1 year of follow-up. The absolute risks of outcomes were assessed, and associated factors were evaluated. Based on age and comorbidities, patients were stratified in 4 groups: low (<75 years + 0 comorbidities), low intermediate (≥75 years/1 comorbidity), high intermediate (≥75 years + 1 comorbidity/2 comorbidities), and high risk of death (≥75 years + ≥2 comorbidities).

Results

In total, 4,202 patients (62.9% men) were identified. Within 1 year after surgery, 504 (12.0%) died and 2,456 (58.5%) were rehospitalized. Factors associated with death included older age (>75 years), chronic obstructive lung disease, heart failure, prior myocardial infarction, prior stroke, liver disease, and kidney disease. The 1-year risks of death among patients in low, low-intermediate, high-intermediate, and high risk of death were 3.6%, 10.3%, 19.6%, and 27.7%, respectively. Diabetes mellitus and chronic obstructive lung disease were associated with an increased incidence of rehospitalization, and the incidence of rehospitalization was similar among the 4 abovementioned groups (57.8%-62.8%).

Conclusions

Mortality and rehospitalization risks after mitral valve surgery varied substantially with age and comorbidities. High-risk patients with >25% 1-year mortality may be easily identified using readily available clinical features.

Trial Registration

In Denmark, registry-based studies that are conducted for the sole purpose of statistics and scientific research do not require ethical approval or informed consent by law. However, the study is approved by the data responsible institute (the Capital Region of Denmark [approval number: P-2019-348]) in accordance with the general data protection regulation.

Section snippets

Background

Mitral valve surgery is a complex procedure with significant strain on the patient's cardiac function, hemodynamics, and systemic organ function, which in turn may affect short-term as well as long-term outcomes—although such data are sparsely described. Given that patients with mitral valve disease are often above 60 years of age and comorbid, surgical risk becomes important in the clinical decision making for mitral valve surgery. Less invasive percutaneous therapies such as edge-to-edge

Data sources

This was a retrospective cohort study using Danish nationwide registries and a cardiac surgery database composed of detailed clinical and procedural information from January 1, 2000 to December 31, 2018. All Danish residents are assigned a unique and permanent civil registration number allowing accurate linkage of nationwide administrative registries at an individual level. For this study, data from the following Danish administrative registries were obtained: (1) The Danish National Patient

Baseline characteristics

In the period from January 1, 2000 to December 31, 2018, 4,202 patients (61.9% men) ≥60 years of age underwent mitral valve surgery (ie, valve repair or bioprosthetic/mechanical valve replacement with or with-out other concomitant cardiac surgery) with a median age at time of surgery of 71.2 years (25th-75th percentile 66.2-76.1) (Figure 1). In total, 1,682 (40.0%) patients underwent isolated valve repair, 1,193 (28.4%) underwent valve repair with other concomitant cardiac surgery, 422 (10.0%)

Discussion

In this nationwide study, we examined the 1-year risk of mortality and incident rehospitalization following mitral valve surgery in the period from January 1, 2000 to December 31, 2018. The study yielded the following 4 major findings: first, mitral valve surgery was associated with a high (12%) 1-year risk of postoperative mortality. Second, more than half (59%) of the patients were rehospitalized within 1 year following discharge from mitral valve surgery. Third, factors associated with an

Conclusion

Mitral valve surgery was associated with a high 1-year risk of postoperative mortality. Based on risk factors including age and relevant comorbidities, we could stratify patients in 4 groups estimating the 1-year risk of postoperative mortality. By simple and readily available patient characteristics, we could identify a high-risk population with a 1-year mortality above 25%. More than half of the patients who underwent mitral valve surgery were rehospitalized within 1-year, however, the risk

Conflicts of Interest

Køber serves as a consultant for Boehringer Ingelheim, and has received other support from AstraZeneca, Novartis, and Novo Nordisk. Fosbøl, Havers-Borgersen, Carranza Butt, and Strange reported no financial interests.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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